I hope i have updated my case study okay. Quest has an acute laminitis episode - started 14th December. I've always roughly followed the ECIR diet but tightening up and doing it as well as I can now. My priority is giving her the bute so I had stopped her normal balancer/linseed/fenugreek/beet bulb meal as she stopped eating it. But I'll try again from tonight onwards as she's hungrier now I've dropped the hay. I thought that 1.5% was on 100% dry matter basis so had been adding 10% for water content, but I realise that was wrong so am adjusting my measurements. 

She seems no more comfortable on the bute, but has no pulses now. the hooves are hot.  Does this mean that there is likely rotation? I'm going to ask the vet to come out tomorrow to do xrays. My trimmer is due to come on Thursday - she's great and follows ECIR. 

If there's rotation, and bute isn't helping at the moment, is it a hopeless case? 

I also have some EVA mats and am going to make some pads and duct tape them on. My trimmer said to cut out an area around the toes so there's no pressure there. will this definitely be okay to do? 
--
Carly Butler
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest

Thanks Sherry. Her hooves feel very warm though - how would I know the difference? I have looked at the winter laminitis info, but am concerned that if ice helps normal laminitis then heat wouldn't be a good thing?

She does have a rug on and feels warm. The temperature is rising today. 

I'll look through the links and search.

She weighed 566 in march/April and last had insulin checked in 2022 - the vets haven't wanted to check insulin since then despite my asking. I asked again most recently in November when she was in for treatment if they could take bloods but they didn't. They say they can't take bloods now as the delivery system in the UK isn't working. 


--
Carly Butler
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest

I can't seem to find any scientific research on winter laminitis - am I missing something? I understand there is a theory about the mechanics, and observations about hooves being cold, and suggestions about leg warmers but that seems to be it?

When I first took her off the grass I wrapped her legs, but I worried about them overheating.

If it's winter laminitis will there be no rotation? And would warming the legs completely relieve the pain? 

I can feel pulses this morning. She's no better. I think she lay down most of the night and struggled to get up again. 
--
Carly Butler
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest

Hi Carly,

Just butting in here to say it is discouraging (as you well know) not to have the support of your vet. After all is said and done, though,  she is your horse,and relying on you (as with all of us) to be her advocate.
Hang in.

--
Lorna in Eastern Ontario
2002

I know, I'd hope they'd take bloods when they saw her last Thursday. I should have insisted, but I was feverish and fuzzy with flu. They've called back to say they'll do xrays on Weds. I expect that'll be too close to Xmas for bloods anyway. 


She is on the emergency diet. She's always been on low sugar and starch diet with soaked hay. The only thing I've done wrong (aside from grass and feeding closer to 1.75 than 1.5) is give her spillers happy hoof molasses free lately as it encouraged her to eat a supplement I was feeding (Ron Fields UlcEx plus). It's very low sugar and starch, but has alfalfa pellets and a couple of other bad things. 

I couldn't soak for 4 days as everything froze but its thawed now. That coincided with the laminitis, so it wasn't a trigger. But it's not helped management - right at the point I really needed it. 

I don't feel like there's much I can change to lower insulin - other than being off grass. She's been off it 7 days now though. 

I've been feeding 8.25kg of hay, with pulp and pellets taking it to 8 5 total. Its weighed and in small holed nets, with some of the night hay in a ground slow feeder. She has 1.4kg at 5.30, 9.30, and 1.30, then 4kg at 5.30pm.

I'm struggling as I know often horses have all the wrong food and way too much so they go on the diet and things improve. There's very little to change for us though other than quantity and no grass. Unless the happy hoof is the ultimate culprit here? 

It's 12 degree here now so I won't wrap feet. 

I'll try get feet pics though her feet are hard to see in the bedding. I will see if I can have her stand on a mat briefly. I am reluctant to lift her feet.


--
Carly Butler
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest

Quick update, the vet just called (in a hurry!) and said usually bute would help even if there is rotation. She said it questions the diagnosis. So now I'm wondering what other diagnoses might there be, if not laminitis?? She has the classic lami stance, can barely move. Sudden foot abscesses in both front feet? 

Some kind of sudden nerve impingement? 
--
Carly Butler
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest

Carly,

For diagnosis of the cause of this pain you must insist on insulin testing.  Ask for glucose and ACTH, too.  They can pull blood on Wednesday, centrifuge it, and freeze it for a couple weeks if shipping/holidays are a concern.   It will delay your results but that's better than no results.  Bute will not help with metabolic induced laminitis (the cause of 90% of laminitis cases) as Bute is a non steroidal anti-inflammatory and this type of laminitis is NOT inflammatory.

Getting her off grass permanently (rye grass and clover are particularly risky, but no grass will ever be safe for Quest), and soaking her hay for now will make a big difference.  Remove everything else that's not on our Emergency Diet, at least until she stabilizes.  Usually pain levels get better within 3 days of those changes, so anything beyond that means the insulin is still elevated and medication is indicated: either Metformin to lower insulin (30mg/kg body weight BID) or pergolide if she has PPID (need bloodwork to confirm and test for PPID with ACTH, first), and/or the trim is exacerbating pain from damage to the hooves.  Once you have your xrays,  you should take a full round of hoof photos and upload them to an Album in the Case History sub-group:
https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help
Double abscesses on both fronts are much less likely than acute laminitis at this stage.  Given her history I wouldn't even consider nerve impingement...she clearly has EMS, has been 'walking on a tightrope' for years, and something pushed her over the edge into acute laminitis.  Probably access to winter grass, but just getting older and a reduction in exercise, or everything combined can bring this on.

You can feed frozen hay so don't let cold temperatures stop you, but you might need a larger holed hay net or you might need to feed it loose.  You only need to soak it for 1 hr in cold water, it will not freeze in that time frame. 

--
Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Snickers' Case History
Snickers' Photo Album
--
Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Snickers' Case History
Snickers' Photo Album

Quest was lying down in considerable pain this morning so I had the vet out. Not colic, just pain. She thinks there's now a ridge by the coronet suggesting the foot is sinking. 

She has prepared me to have to consider euthanasia after xray tomorrow.  

She suggested remedial shoeing as an option if no sinking. 

But either way, given her other physical issues, and the extent of her pain I think there's nothing I can do. 

I did insist on a blood sample though, for what it's worth. 
--
Carly Butler
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest

Hi Carly

There are many here who have been exactly in your shoes and have come out the other side.

You don't have to consider euthanasia, but the rads and blood work will tell you lots about the work you will need to do.

It is good that she is lying down. Keep an eye on  is how much water she is drinking water and passing manure.

You likely will need a new vet. And a good trimmer.

https://www.ecirhorse.org/laminitis.php

We know how very hard this work is.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President 2021-2022

HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993

Carly,

Not everyone can make the commitment and not every horse will be determined, but even horses that have had their coffin bones penetrate their soles can recover. Sinking is not an automatic death sentence. Read this http://www.ironfreehoof.com/severe-laminitis-case-study.html and I hope that Lorna is reading today and can give you an overview of what she managed.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

My trimmer came to see Quest. She was lying down so she got to look at each foot. There is absolutely no stretching on any white lines and her soles are as hard and solid as ever. She only responded to hoof testers on the right hoof and is hot on the lateral toe. She thinks it's highly likely she just has an abcess in the right foot. Obviously I have to wait and see what xrays show, but I'm hopeful for now ... 
--
Carly Butler
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest

Abscess pain can be worse than laminitis, so hang in there.  Bute will delay the resolution of the abscess, but giving jiaogulan can help speed it up by increasing circulation to the hoof.  The abscess pockets may or may not show up on xray.

I've seen a ridge at the coronet develop before an abscess burst on my horse, but it can also be a sign that penetration is about to occur.  Penetration is rare with metabolic laminitis though, which is more likely to be what you are dealing with given Quest's history.  Penetration seems to be more typical of laminitis from SIRS or ingesting a poisonous food, which can be very severe, progressing quickly and is not helped by dietary changes.

If you can keep her barefoot and in boots with pads that is what we advise until she's ready to be ridden again.  Your trimmer will probably need to make frequent adjustments every few weeks to keep her comfortable and shoes will prevent that.  Plus, shoes put a lot of stress on the weakened laminae that have been damaged by the laminitis.

--
Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Snickers' Case History
Snickers' Photo Album

Hi Carly,

I hope you can find the time to read Druid's story(the link above from Dr.Kellon). Paige  has provided awesome documentation of Druid's nightmare.
Five of my then-herd of 9 went through the same nightmare.  They all lost all 4 hooves,in the winter. My then-vet felt there was no hope. He had no experience with their situation.Thanks to a vet from Out West(where this kind of toxicity is common),and Dr. Kellon and her awesome advice given here, my local trimmer, and an amazing trimmer ,who travelled here from NH, 4 of the boys made a text book recovery, and had new hooves within a year.The Morgan pony  lived to be in his 40's, and the others over 25. The 5th was more problematic,but tenacious,and lived to be 30.
It was agony for all of us. I made a deal with them that as soon as they wanted out,I would be there.Otherwise, I would be there,too. It definitely taught me to live in the moment,and to focus on the positive,mostly so the boys wouldn't pick up on my terror.

We and our horses are all different, but that's my 2 cents.

Keep breathing....in AND out .


--
Lorna in Eastern Ontario
2002

Thanks all. Druid's story, and yours Lorna, are horrific but inspiring. I feel more hopeful at the moment. A lot hinges on the xrays. 

I won't consider shoes, despite what the vet suggests. 

I was feeding jiaogulan until I started feeding bute. The vet has suggested paracetamol- she said she's never seen it be effective, but other vets have.


--
Carly Butler
Nottinghamshire, UK, 2020
https://ecir.groups.io/g/CaseHistory/files/Carly%20and%20Quest